Hospital pharmacy delaying patient discharge

[Rillington]

I have recently had various relatives in hospital. Every time they are discharged they have to wait hours for their medication. This means they are taking up a hospital bed they don't really need.

The last relative was told at 8a.m. they could go home that day. The medication eventually arrived at 9.45p.m.

Is this normal or just a problem at our hospital?

@CovoidOfAllHumanity

Lately my MH trust got a new electronic notes system but our prescribing is still on paper charts

Drs and pharmacists would have loved to have e prescribing but we literally could not afford to buy the prescribing module of the new software.

It's going to be all about resources
Tory government. People don't want to pay more taxes. You get what you pay for.

Rubbish like we get a say in how much tax we pay

It's very hard to retain staff in the NHS. So they are always short staffed.

The Discharge Lounge at our hospital (where I worked until recently) was repurposed during the first wave of Covid & looks unlikely to ever be reinstated. This is exactly what a Discharge Lounge was for.

Pharmacy do not prioritise take home meds. They prioritise urgent ward meds. It's also worth remembering that the Dr can tell a patient they are free to leave at 8am during ward round - but then not send the prescription to pharmacy until 2pm.

I agree it's frustrating for patients & staff alike.

So annoying, my husband was told he's been diacharged at 7 pm and medivines didn't artive till 11:45 pm. He came home at 12:15 am following day!

Normal. Been the case EVERY time I’ve been discharged.

I think people are imagining that prescribing discharge meds is just the push of a button

If we had integrated systems maybe it would be but in most places it's a 20 min at least job x however many patients of transcribing a paper chart onto either another piece of paper or into an electronic system. The discharge paperwork usually also includes a summary of the admission and the follow up arrangements that also had to be typed by the hapless junior Dr. Given shift systems as they are they may very well have no idea what the patient actually did have done and will need to read back over notes and summarise.

Clearly it is important that there is a correct record of what was wrong, what was done, and what medications are and what follow up arrangements should be. This is crucial isn't it and you can see it would be longer than one press of a button to achieve it?
That's what is taking the time probably not 'waiting for meds' as such.

If we had the luxury of just saying the discharge would be the next day it would all be seamless but there are people waiting in A&E for the bed the same day.

Justasking we live in a democracy
One of the main things people make voting decisions on is taxation rates

I’ve spent a lot of time in King’s and have never had an issue.In fact the pharmacist has come to see me a day before I’ve been discharged to discuss meds etc.

Also I know they have an agreement with a pharmacy somewhere down the road who fill prescriptions for them on occasions.

Last time I was in I was told I could go home at around 6 and left the hospital at 7:30.

@BungleandGeorge

Nothing in what I have written suggests that the system in Austria is any less safe than that in the UK - there is no suggestion that they are cutting back on safety or on patient care.

On the subject of patient care though, having a patient waiting around for hours is hardly being respectful of the patient's needs or wishes (which is what started this thread) - and meanwhile, the next patient waiting in A&E for the bed to be vacated is hardly having the best experience either.

Things would be better organised and a more pleasant experience if there were spare beds so that we could organise everything nicely for the next day

That is what usually happens at my MH trust. I can usually give a discharge date at least a few days in advance and there is none of this unseemly scramble.

It's about bed pressure ultimately and that's about resources.

My Uncle had a hip replacement last and we were told he was going to be discharged. DH collected him and took him home but needless to say his medication wouldn't be ready until later that day, around 10pm and it was essential he had it that night.

I phoned the ward to check DH had got the time right (he's partially deaf) and was told he had, the medication had to come from another hospital as the one my Uncle was in didn't have a pharmacy. I asked if I could go to the pharmacy to collect it earlier and was told no, I had to wait. In the end I phoned the ward a coupled of times on the off chance it was there and it was there at 8pm.

I didn't like to keep hassling the ward but my Uncle was shattered and wanted to go to bed but apparently needed the medication. If I'd waited until 10pm the poor bugger wouldn't have got to bed until midnight by the time I'd collected it, delivered it to him and he'd taken it and got himself sorted out!

Everyone have summarised everything up quite well here. I am a junior pharmacist and this is what I do in a day at my usual trust:

-First off is a pharmacy meeting where you see what the workload is and decide who is covering which ward.

-Go up to the ward and check for any urgent medication orders first.

-Complete drug histories for new patients (if you are lucky a technician can do this for you) and ensure all of their medicines are prescribed/anything that is held is held.

-Review existing patients on the ward I.e checking their renal and hepatic function and adjust meds accordingly, catch up on notes to ensure the plan is actually being followed, monitor for side effects, look at what could be deprescribed, check for interactions etc. I can also be looking after 30 patients easily.

-Discharges. As previous posters have said, the helpful consultant will usually tell the patient you can go home today. The drs need to finish the ward round as even though we have an integrated IT system, there isn’t time in the ward round to write up the discharge. The ward round usually finishes at 12-1300. The Discharge summary needs to be written by the dr before I clinically screen it and write my own notes to the GP detailing what changes we have made, what monitoring they need to do etc. The discharge meds are never done correctly the first time round (why did you add all of medicines that have been stopped and missed off all the new ones 🙃) and because most of us aren’t prescribers, we need to sort these issues with the Dr before the medicine can actually be dispensed. Dispensing will usually take at least an hour because the pharmacy is dispensing orders for inpatients as well as discharges.

Bear in mind you can never do your job uninterrupted (I have nurses and drs asking me questions often), you have to be highly accurate and fit in a lunch break somewhere. I do wish we had more staffing so I can focus more on patients and counselling them on new medicines etc.

Interestingly at my new trust, pharmacists write the discharge prescription (it’s transcribing when we do it), however, the doctors aren’t available to speak to until after the ward round and I need an accurate list of who’s going home so that I don’t waste time (dr tells me one thing, clinical clerk says another, no one has kept up with OT/PT and at the daily board meeting everything changes).

Sorry for the essay!

Gosh, I remember this, but the anxiety for me waiting was amplified by a terrible weather forecast, warning of a blizzard due late afternoon. I was going home on crutches after major leg surgery.
I was told I could go home at around 8am, but had to wait for meds to arrive. They came at around 10, but then I was told I "just" had to wait for the surgeon to take a quick look at the wound. He was in theatre. He finally arrived on the ward at around 6pm, barely looked at me, other than to say, "yes, that's fine." Then I had to wait for a porter and a wheelchair and someone to carry all my stuff (bag/crutches/zimmer and perching stool). A sweet carer intervened, stole a wheelchair from somewhere and wheeled me down, with ds carrying all the gear.
Dh was waiting at the entrance outside in the blizzard and I had to negotiate getting in the car without slipping or jarring my leg. Then we had to creep home in the snow, arriving at about 10pm, and get me into the house up a snowy driveway.
Nightmare.

Thankfully our hospital has been very quick, making sure I had the medication before they even started doing the discharge papers

I work in a hospital that has electronic notes and prescribing, ward pharmacists etc and it still takes time

I always try and draft my discharges when I've got a free minute so when we decide a patient is going home can just confirm it and its ready, but it still takes hours for patients to be discharged. Theres only so much you can draft the day before as you won't necessarily know what meds a patient needs to go home with.

Also yes consultants will say on the morning ward round you can go home providing your bloods are okay, or you just need a scan and then you can go. Consultants will promise things that simply cannot happen asap. They will say things like 'Twat will just chase your scan and it'll be done this morning' when I've already been chasing the scan and its not happening that day. Patients hear home from the consultant but its still going to be hours

They might also give you 50 tasks to do on the ward round, all to be done by 10am when the round doesn't finish till 12, and they will tell all the patients that it will be sorted this morning. Some consultants really have a very poor understanding of time.

Often hospitals wont allow patients to go home with the green prescriptions as it costs the NHS more money, which is really frustrating from our side if its just one med that the patients needs thats going to take hours. Especially with A&E patients.

I think tbh its a multifactorial thing, everyone is so busy that each step takes time. And its understandable that discharges are not always prioritised. The hospital has 1000 patients, and unfortunately things do take time. Theres lots of general beurocracy tbh in hospitals which slows everything down and patients tend to suffer as a result. I tend to find each department has their own rules and the rules don't always correlate with each other

Normal. But I wouldn’t necessarily blame the pharmacy alone, it takes a while system to discharge a patient so while the decision might be made at 8am there’s actually quite a bit of work that does into it. Junior doctor needs to write the discharge letter (prescription can’t be made until this is done) this is usually done after the consultant ward round and includes trawling through the patients notes to summarise the full admission and they may have many to do that day. The pharmacy will then make the order and send to the ward. The nurse then needs to check the order, again may have many patients to discharge so multiple orders the check and go through with the patient. And this is the process for a simple discharge if more complex there may be other agencies involved like arranging ambulance transport for discharge, home carers to contact, district nurses to contact, social workers, ensure patients discharge has been approved by physios, OT, dieticians, SALT etc etc. So to the patient and family it can seem like it’s taking forever there is often a lot that goes into getting a patient home safely and this is done in between of day to day jobs such as ward rounds, drug rounds, meal times, etc.

Last time my DH was released they didn't wait for the pharmacy, they just sent the drugs to us afterwards in a taxi!

My local hospital has a discharge lounge.

Soon as I was told I could go I got dressed, packed my stuff & phoned my brother, who was coming to get me. I was transferred down and waited til everything was done.

My meds were delivered there and while I was waiting there was tea, coffee & a sandwich provided. It also has a special exit so people collecting you can park right at the door rather than the car park.

It's a great system

This has been a problem for decades.

There used to be porters who's entire job was to walk between the pharmacy and the wards / clinics with prescriptions.

But, managers who have never worked a day on a ward see them as an easy way to cut costs, not realising they are storing up costs in other ways.

Some hospitals had 'discharge lounges' but even if they still exist I imagine covid has put play to that.

Normal at my hospital too. We try and get them done the a day before discharge. But doesn't always happen. It's infuriating. Especially as we have patients who live up to 70 miles away.

Pharmacy staff need to work shifts as nurses do. Was rounds happen at 7.30- 8. We do t see a pharmacist until gone 10am.

It’s normally, and not just restricted to the UK. I’ve seen USA-centric nursing memes with jokes about pharmacy delaying the patients discharge.

We will allow parents toco
R back for them if they want too. But many don't.

It's incredibly annoying. You can only use the script in the hospital as it is on a different form and normal pharmacies can't fill it.
A lot of the time though the doctor will tell you you can go today and to wait for your prescription [ which you never see ]. So a lot wait until pharmacy bring it to you.

When my son was discharged from hospital a few years ago [ age about 13 I think ] after he had been in two weeks we were told to wait for pharmacy to bring the prescription. We waited nine hours!!! It finally arrived at 1 am. We were both shattered, his bed had already been given to another patient so we couldn't even stay another night.
We had a 45 mile drive home, so I had no choice but to wait as I didn't want to have to do a 90 mile round trip the next day to collect the medication.

This has been an issue for yrs, at my local hospital if you didn't get them by mid afternoon you would have to stay in another night.